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FIRST NATIONAL eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

 

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1–7
DD Take Care Holistically Video 1–4 Chat with Dr KK On life Style Disorders
Health Update Video 1–15 Science and Spirituality
Obesity–Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

4th September 2012, Tuesday

Fit at 50 you will live longer

A new study by Dr. Jarett Berry at the University of Texas Southwestern Medical Center and published in the journal Archives of Internal Medicine found that fit 50-year-olds are less likely to be afflicted with chronic disease as they get older than those who are sedentary.

The study also makes the case for more vigorous exercise. Berry states, "We know from prior literature that higher-intensity exercise tends to translate into more fitness.

Not only do the people with higher fitness live a little bit longer, the onset of chronic disease occurs even later, so that the amount of time you spend in your life with chronic diseases is compressed into a smaller period of time.

For Comments and archives…

Dr KK Aggarwal
Group Editor in Chief

 
    Constipation Update

What is the role of endoscopy in constipation?

Colonoscopy can identify lesions that narrow or occlude the bowel. Colonoscopy is preferable in constipated patients with anemia, rectal bleeding, hemoccult positive stools, obstructive symptoms, recent onset of constipation, weight loss, a change in stool caliber, or rectal prolapse because of the ability to visualize the entire colon.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Rapid flu test more accurate when positive

Audio PostCard
 
    Photo Feature (from the HCFI Photo Gallery)

Workshop for Teachers on Proper Hygiene in schools

Heart Care Foundation of India and DAV School, Kailash Hills organized a workshop on health and hygiene for teachers

 
Dr K K Aggarwal
 
    National News

Rotavirus infection costing India around Rs 250 cr a year

New Delhi: A study by researchers from the All India Institute of Medical Sciences, Christian Medical College, Vellore, and Tufts University School of Medicine, Boston — published in the current issue of the Indian Journal of Medical Research — has estimated that every hospitalisation due to rotavirus infection, the commonest cause of childhood diarrhoea, costs a family an average of Rs 2,956 in treatment expenditure and man-days lost. As per a 2009 study by the Centers for Disease Control and Prevention, Atlanta, rotavirus annually causes an estimated 1,22,000-1,53,000 deaths and 4,57,000-8,84,000 hospitalisations. Thus, as per findings of IJMR study, the infection could annually cost over Rs 250 crore, exclusive of expenses of outpatient treatment. The research advocates a universal rotavirus vaccination programme and need for local manufacturers. ICMR is in the final stages of rotavirus vaccine trial, started two years ago. At $ 53.75, the average expenditure in India is at par with the range of cost estimates for diarrhoeal hospitalisations available for developing countries like Vietnam ($ 36), Ghana ($ 65.14-133.86). “To understand the scale of an infectious disease problem, it is very important to understand the economic burden it creates. This is the first of a series of studies to assess how much common diseases cost...,” said Dr Shobha Broor, Professor of microbiology, AIIMS, and one of the authors of study.

A total of 211 patients from eight hospitals in Delhi, Vellore, Kolkata and Pune were enrolled. The average cost of treatment in a government setup was Rs 233 while that in a private hospital was Rs 6,071. Of the vaccines available, the two commonest cost between Rs 2,200 and Rs 2,700 per course. “... a universal vaccine programme for India could be cost-effective based on a decision rule whereby an intervention that averts one disability-adjusted life-year for less than India’s GDP per capita ($ 1,017 in 2008) is considered to be a highly cost-effective intervention,” it said. (Source: Financial Express, Sep 03, 2012)

For comments and archives

4th Dil Ka Darbar

September 23, 2012, 9:00 AM - 6:00 PM , Tal Katora Indoor Stadium, Connaught Place, New Delhi

A non stop question answer-session between all top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press.

My Profession My Concern

Improve effective Communication or face a trial

Effective communication:

  • Reduces errors
  • Improves patient safety.
  • Improves family satisfaction, clinical decision-making, and the psychological well-being of family members.

Goals

Effective communication should be

  • Timely
  • Accurate
  • Complete
  • Unambiguous
  • Understood by the recipient

Error-prone situations

  • Patient care orders given verbally
  • Patient care orders given on telephone
  • Reporting back of critical test results, such as the clinical laboratory telephoning the patient care unit to report the results of a STAT test.

Identifying methods

Communication can be

  • Electronic
  • Verbal
  • Written

Measurable Elements

  • The complete verbal and telephone order or test result should be written down by the receiver of the order or test result.
  • The complete verbal and telephone order or test result should be read back by the receiver of the order or test result.
  • The order or test result should be confirmed by the individual who gave the order or test result.

Legal implications
The 7 dimensions of care that are of concern to patients are as follows:

  1. Respect for patient values
  2. Care coordination
  3. Communication with providers
  4. Enhancing physical comfort
  5. Emotional support
  6. Involving family and friends
  7. Managing care transitions

Reference

  1. As per a supreme court of India judgment: “ 2. No prescription should ordinarily be given without actual examination and (3) the tendency to give prescription over the telephone, except in an acute emergency, should be avoided.” (SCI: 3541 of 2002, dated 17.02.2009, Martin F. D'Souza vs Mohd. Ishfaq: Markandey Katju and G S Singhvi, JJ)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Valvular Heart Disease Update

What are the most common causes of significant mitral regurgitation in the elderly?

The causes are mitral valve prolapse and ischemic heart disease.

Surgery for severe chronic mitral regurgitation is recommended for young asymptomatic patients with early evidence of left ventricular dysfunction but the same is not indicated in patients over age 80 to proceed with surgery unless symptomatic.

(Experts: Dr Bhabha Nanda Das and Dr Ganesh K Mani, Dr. Yugal Mishra, Dr Deepak Khurana, Dr K S Dagar, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

New tick-borne disease found

A new virus, dubbed "Heartland virus," is being spread to people by ticks common in the Southeast, the CDC reports. The only known cases are two northwestern Missouri men who fell ill in 2009. Ticks had bitten both men, but they did not get better after treatment with antibiotics. Tests later showed that the men did not have any tick-borne bacterial diseases. But CDC researcher Laura K. McMullan, PhD, and colleagues did find something else: a previously unknown virus in the patients' blood. "This virus could be a more common cause of human illness than is currently recognized," they suggest in the New England Journal of Medicine. (Source: Medscape)

For Comments and archives…

Enzalutamide gets FDA nod for late-stage prostate cancer

The US Food and Drug Administration (FDA) has approved enzalutamide (formerly known as MDV3100) to treat men with metastatic castration-resistant prostate cancer that has spread or recurred. Developed by Astellas Pharma US Inc and Medivation Inc, the drug will be sold as Xtandi. It was reviewed under the FDA's priority review program, which provides for an expedited 6-month review for drugs that may offer major advances in treatment or that provide a treatment when no adequate therapy exists. (Source: Medscape)

For Comments and archives…

Poorer prognosis with multifocal glioblastoma

Patients diagnosed with multifocal disease on presentation have significantly worse survival than those with solitary tumors, even in the "temozolomide era," according to a study published online August 24 in the Journal of Neurosurgery. (Source: Medscape)

For Comments and archives…

Newest ED drug works in less than half hour

The newest drug for erectile dysfunction (ED) may work in as little as 15 minutes after dosing, researchers said here. A significantly larger proportion of patients had successful sexual encounters within 15 minutes of taking avanafil (Stendra) compared with placebo (P=0.05), John Mulhall, MD, of Memorial Sloan Kettering Cancer Center in New York, and colleagues reported here at the World Meeting on Sexual Medicine. Approved, avanafil is the first ED drug to be introduced to the market in nearly a decade. It's a highly specific phosphodiesterase type 5 (PDE5) inhibitor that is rapidly absorbed, typically within 30 to 45 minutes. (Source: Medpage Today)

For Comments and archives…

 
    Twitter of the Day

@DrKKAggarwal: DD India's Take Care Holistically-Cholesterol..http://youtu.be/tyXCfASk0fU

@DeepakChopra: Perceptual reality creates pain & pleasure. Fundamental reality is the bliss beyond both.

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Diet in Jainism

According to Samani Charitra Prajna, the core principle of Jainism is nonviolence and it is recommended in the scriptures to live nonviolent life. Food is the main source of energy to survive in the world. Bhagwan Mahavir talked about two types of diet – Hitkari (Beneficial) and Mitkari (Moderate). Jains are lacto vegetarian and many are even vegans.

For Comments and archives…

 
    4th Asia Pacific Vascular Intervention Course (APVIC)
  • 4th Asia Pacific Vascular Intervention Course–Excerpts from a Panel discussion Read More
  • The 4th Asia Pacific Vascular Interventional Course begins Read More
  • Excerpts of a talk and interview with Dr. Jacques Busquet by Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Editor–in–Chief Cardiology eMedinewS Read More
  • 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • Press Conference on 4th Asia Pacific Vascular Intervention Course – Dr KK Aggarwal with Faculty Read More
  • 4th Asia pacific vascular intervention course Read More
  • 4th Asia pacific vascular intervention course paper clippings Read More
 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

How can ovulatory problems be detected?

  • Transvaginal ultrasound: Follicular growth can be measured with ultrasound. This is a painless procedure usually done with a probe inserted into the vagina, but may be done with an external probe placed on the abdomen. Prior to ovulation, the follicle is thin-walled and filled with fluid. As the egg inside the follicle develops, the follicle increases in size. Ovulation generally occurs when the follicle measures about 1.8 to 2.5 cms.
  • Endometrial biopsy: Progesterone, a natural ovarian hormone, helps prepare the endometrium to receive an embryo. An endometrial biopsy is occasionally used to determine if a woman has ovulated, and if the endometrium has been adequately stimulated with progesterone. During this office procedure, a small amount of endometrial tissue from inside the uterine cavity is removed and examined under a microscope. This test is performed just before menstruation is expected to begin. In order to interpret the endometrial biopsy, the physician will need to know the day that menstruation begins after the biopsy.
  • Tests to measure hormone levels: Elevated progesterone levels in the blood usually are associated with ovulation. A blood test to measure progesterone can be performed about one week before the anticipated onset of the next menstrual period. The LH surge occurs just before ovulation. Estrogen is secreted by the growing follicle and rises rapidly prior to ovulation. If ovulation is being induced with fertility drugs, frequent estrogen level measurements may be needed to determine follicular growth.
  • Basal body temperature chart: The BBT chart helps to monitor the duration of the different phases of the menstrual cycle, and can help determine if and when ovulation has occurred. During the follicular phase, the woman’s body temperature is relatively low. When progesterone production begins at ovulation, it produces a temperature rise with a minimum increase of 0.5oF. An increased body temperature for several days indicates ovulation has occurred.

For Comments and archives…

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Investigating transfusion reactions

  • Immediately report all acute transfusion reactions to the clinician and to the blood bank that supplied the blood.
  • Record the following information on the patient’s notes:
    • Type of transfusion reaction
    • Length of time after the start of transfusion that the reaction occurred
    • Volume, type and blood unit numbers of the blood components transfused.
  • Take the following samples and send them to the blood bank for laboratory investigations:
    • Immediate post-transfusion blood samples (clotted and anticoagulated) from the vein opposite the infusion site
    • Blood unit and BT set containing red cell and plasma residues from the transfused donor blood
    • First specimen of the patient’s urine following the reaction.
  • Complete a transfusion reaction report form and send it to the blood bank.
  • Record the results of the investigations in the patient’s records for future follow-up, if required.

For Comments and archives…

 
    Fitness Update (Rajat Bhatnagar, MonaVie, www.mymonavie.com/sonraj)

Physical training for people with asthma

Asthma is a respiratory condition that causes the airways to become swollen and narrow, and leads to symptoms including shortness of breath, wheezing, and coughing. Some people with asthma may avoid exercise or tolerate it less well than their healthy counterparts. Recently, a study published in the Cochrane Database of Systematic Reviews evaluated existing literature on asthma and physical activity to gain a better understanding of how exercise impacts the respiratory and overall health of people with asthma.

The reviewers looked at 19 studies including 695 participants. Results showed that physical training was well tolerated and did not result in worsening of asthma symptoms. In addition, training improved cardiorespiratory fitness and maximum expiratory ventilation (or the maximum amount of air a person can breath out in one minute) without any effects on lung function at rest. There was also some evidence to suggest that physical training may have positive effects on health-related quality of life. The authors conclude that people with asthma should be encouraged to engage in regular physical activity without fear of worsening symptoms.

For comments and archives

 
    An Inspirational Story (Dr GM Singh)

The 6 enemies of greatness (and happiness)

The following six factors can erode the grandest of plans and the noblest of intentions. They can turn visionaries into paper-pushers and wide-eyed dreamers into shivering, weeping balls of regret. Beware!

  1. Availability: We often settle for what’s available, and what’s available isn’t always great. “Because it was there,” is an okay reason to climb a mountain, but not a very good reason to take a job or a free sample at the supermarket.
  2. Ignorance: If we don’t know how to make something great, we simply won’t. If we don’t know that greatness is possible, we won’t bother attempting it. All too often, we literally do not know any better than good enough.
  3. Committees: Nothing destroys a good idea faster than a mandatory consensus. The lowest common denominator is never a high standard.
  4. Comfort: Why pursue greatness when you’ve already got 324 channels and a recliner? Pass the dip and forget about your grand designs.
  5. Momentum: If you’ve been doing what you’re doing for years and its not-so-great, you are in a rut. Many people refer to these ruts as careers.
  6. Passivity: There’s a difference between being agreeable and agreeing to everything. Trust the little internal voice that tells you, “This is a bad idea.”

For comments and archives

 
   Cardiology eMedinewS

ESC: Energy drinks may not be all bad Read More

FRANCE 2 registry shows 2011 TAVI patients were older but less ill than 2010 patients Read More

 
   Pediatric eMedinewS

Educating kids about mental illness may reduce stigma Read More

Well-baby dental checks by physicians cut hospitalizations Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of asthma was put on tiotropium.
Dr. Bad: Stop it.
Dr. Good: Continue it.
Lesson: The addition on tiotropium to low–dose, inhaled steroids has been shown to improve asthma control in many studies.

For comments and archives

Make Sure

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.

For comments and archives

 
  Quote of the Day (Dr GM Singh)

If you have zest and enthusiasm you attract zest and enthusiasm. Life does give back in kind. Norman Vincent Peale

 
  Legal Question of the Day (Dr MC Gupta)

Q. What is the summary of the SC judgment regarding termination of pregnancy in a mentally retarded woman?

Ans.

  1. You are obviously referring to the judgment in “Suchita Srivastava & Anr. vs Chandigarh Administration, SC, decided on 28 August, 2009 (Bench: K.G. Balakrishnan, P. Sathasivam, B.S. Chauhan)”.This judgment can be viewed athttp://indiankanoon.org/doc/1500783/
  2. An excellent summary of this case has been published on another web site by a Supreme Court advocate Rakesh Shukla, a Supreme Court lawyer.
    (http://infochangeindia.org/women/judicial-interventions-and-women/
    free-to-choose-mental-retardation-and-reproductive-choice.html) I am reproducing it below. Before reproducing it, I have asked their permission.
  3. Summary as prepared by Advocate Rakesh Shukla In a landmark judgment, the Supreme Court of India struck down a high court order to terminate the pregnancy of a mentally retarded woman, against her will.

The recent Supreme Court judgment reversing a Punjab and Haryana High Court order directing the medical termination of pregnancy of a young adult woman without her consent, on grounds of “mental retardation”, is a landmark decision in the area of reproductive rights. Some years ago, hysterectomies by the authorities on inmates at a mental home for women in Pune focused attention on the rights of individuals categorised as mentally ill.

The current judgment, reported as Suchita Srivastava versus Chandigarh Administration, 2009 (11) SCALE 813, is also remarkable in that it takes on board and acknowledges that judges are also susceptible to unconscious prejudices that impact the judicial decision-making process. In a departure from the practice of judgments freely naming survivors/victims of crimes like rape, here, in a display of sensitivity, the name of the woman has been withheld in the judgment to avoid stigmatisation. The woman (hereafter referred to as ‘AB’) is an orphan who was abandoned by her parents at an early age and lived with the Missionaries of Charity in New Delhi. She was later admitted to the Government Institute for the Mentally Retarded in Chandigarh, and then to Nari Niketan in Chandigarh. On March 13, 2009, AB was shifted to Ashreya, a newly established welfare home. Nari Niketan and Ashreya are both government institutions run by the Chandigarh administration.

On May 16, 2009, a medical social worker and staff nurse working at Ashreya noticed that AB was showing signs of nausea and complained of pain in the lower abdomen. In addition, she disclosed that she had missed her last two periods. A pregnancy test was carried out, which turned out to be positive. On May 18, 2009, a medical board consisting of two gynaecologists and a radiologist was constituted by the administration. It concluded that AB was eight to 10 weeks pregnant.
After confirmation of the pregnancy, the authorities filed a first information report (FIR) with the Chandigarh police, under Section 376 of the Indian Penal Code (IPC), for rape. An ossification test conducted on the woman showed her age to be around 19-20 years. A medical board evaluating the mental status concluded that AB’s condition was that of ‘mild mental retardation’. Another multi-disciplinary medical board set up to submit its considered opinion on the consequences of continuation of pregnancy and the capability of the victim to cope with the same, on May 27, 2009 recommended the termination of AB’s pregnancy.

As there was no clear basis in law for proceeding with the termination, the Chandigarh administration approached the Punjab and Haryana High Court seeking approval for medical termination of the pregnancy, keeping in mind that AB was mentally retarded, an orphan, and did not have a parent or guardian who could look after her and her prospective child.

The high court constituted an expert body independent of the Chandigarh administration, consisting of medical experts and a judicial officer, to look into the facts of the case. The high court framed a comprehensive set of questions to be answered by the expert body in order to ascertain the ‘best interests’ of AB.

The broad findings of the expert body were that AB suffered from mild to moderate retardation that affected her capacity for independent socio-economic functioning and self-sustenance, and that she would need supervision and assistance. She was incapable of distinguishing between a child born before and after marriage, or out of wedlock, and did not comprehend the attached social connotations. AB knew that she was bearing a child and was eager to have one. But she was unable to understand the consequences on her own future and that of the child she was bearing. AB had limited perception about bringing up a child and the role of a mother. Although she had enough physical ability to bear and raise a child, retardation limits the mental capacity to bear and raise a child in the absence of adequate social support and supervision. AB had limited understanding of the sexual act and of the concept of getting pregnant. She did not volunteer for sex, and did not like the sexual act. AB had no particular emotions on account of the pregnancy being caused by rape. She was happy with the idea that she had a baby inside her, and looked forward to seeing it. The pregnancy did not pose any particular risk of physical injury to AB. The possibility of complications like an abortion, hypertension, prematurity, low birth weight, and foetal distress was the same in any pregnancy among women of this age-group. AB’s spinal abnormalities and gait defects were not indications of the need to terminate the pregnancy. Similarly, hepatitis B infection was not an indication for termination of pregnancy, and transmission from mother to child could be prevented.

AB needed a congenial and supportive environment for herself and for the safe tenure of her pregnancy. Social support and care for mother and child were held to be crucial components. As to the prudent course to be followed, the expert body took the view that any decision taken keeping AB’s best interests in mind as well as those of her unborn child had to be based on a holistic assessment of physical, psychological and social parameters.

The high court directed the termination of pregnancy by an order dated July 17, 2009. It was left to two public-spirited individuals to move the Supreme Court against the high court order directing termination of pregnancy. The appellant, Tanu Bedi, appeared in person on July 20, 2009, stressing urgency as AB was more than 19 weeks pregnant by then and the statutory limit of 20 weeks for termination of pregnancy was fast approaching. The Chandigarh administration made submissions in favour of termination of pregnancy. In support of the administration’s stand, senior advocate Colin Gonsalves also appeared on behalf of an intervener. After hearing counsel and considering the opinion of medical experts, the Supreme Court granted a stay on the high court order.

The apex court examined the provisions of the Medical Termination of Pregnancy (MTP) Act, 1971 and noted that consent is an essential condition for performing an abortion on a woman who has attained the age of majority and does not suffer from any ‘mental illness’. The court also examined the issue of the exercise of (I)parens patriae(/I) jurisdiction by the courts, that is, the state must make decisions in order to protect the interests of those persons who are unable to take care of themselves. It noted that the two standards for exercising this jurisdiction are the ‘best interests’ test and the ‘substituted judgment’ test.

The court noted that a woman’s right to make reproductive choices is a dimension of ‘personal liberty’, as understood under Article 21 of the Constitution. Reproductive choices can be exercised to procreate as well as to abstain from procreating. The crucial consideration was held to be a woman’s right to privacy, dignity and bodily integrity. Thus, restrictions could not be placed on the exercise of reproductive choice such as a woman’s right to refuse participation in sexual activity or, alternatively, on her insistence on the use of contraceptive methods. Women are free to choose birth control methods such as undergoing a sterilisation procedure. It was observed that reproductive rights include a woman’s entitlement to carry pregnancy to its full term, to give birth, and to raise children.

In the case of AB, the state could claim to be the guardian as she was an orphan and had been placed in government-run welfare institutions. However, the claim to guardianship cannot be mechanically extended to make decisions about termination of pregnancy. The ossification test showed AB to be around 19-20 years, so she did not fall in the category of a minor. AB’s medical condition was described as ‘mild mental retardation’. Under the MTP Act, the pregnancy of a woman above 18 years of age can be terminated with the consent of the guardian only if she is categorised as a ‘mentally ill person’. As per Section 2(b) of the Act: “A ‘mentally ill person’ means a person who is in need of medical treatment by reason of any mental disorder other than mental retardation.” The court observed that it was clear that the expression ‘mentally ill person’ is different from ‘mental retardation’.

The judgment notes that a similar distinction is found in the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 where ‘mental illness’ has been defined as any mental disorder other than mental retardation. Under Section 2(r) of the Act ‘mental retardation’ has been defined as ‘a condition of arrested or incomplete development of mind of a person which is specially characterised by sub-normality of intelligence’. Noting that ‘mental retardation’ has been similarly defined under the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999, the judgment observed that persons in a condition of ‘mental retardation’ should be treated differently from those found to be ‘mentally ill’.

The MTP Act clearly lays down that a guardian can make decisions on behalf of a ‘mentally ill person’, but this cannot be done on behalf of a person who is in a condition of ‘mental retardation’. The court observed that the state must respect the personal autonomy of a mentally retarded woman with regard to decisions about terminating a pregnancy. The explicit consent of a woman categorised as ‘mentally retarded’ may not be a necessary condition for continuing the pregnancy. However, obtaining consent is an essential condition for the termination of pregnancy. The court observed that AB had not given her consent to the termination of pregnancy. It held that dilution of the requirement of consent would amount to an arbitrary and unreasonable restriction on the reproductive rights of the victim/survivor.

Coming to the exercise of (I) parens patrae (/I) jurisdiction by the high court in ordering the termination of pregnancy, it was held that the court should be guided by the ‘best interests’ of the victim/survivor and not of other stakeholders such as guardians or society in general. The judgment observes that AB would need care and assistance, and that would entail some costs. But this could not be grounds for denying the exercise of reproductive rights. The judgment held that the high court could not use the ‘substituted judgment’ standard and make a decision on behalf of AB with regard to termination of pregnancy.

The judgment observes that AB’s case presents an opportunity to confront social stereotypes and prejudices that operate to the detriment of mentally retarded persons. Taking note of the fact that even medical experts and judges may unconsciously be susceptible to these prejudices, the court observes that persons with borderline, mild or moderate mental retardation are capable of being good parents. Mental retardation is gauged on the basis of parameters such as intelligence quotient (IQ) and mental age (MA). It is quite possible that a person with a low IQ or MA can possess social and emotional capacities that enable him or her to be a good parent.

Returning to the facts of the present case, the Supreme Court noted that the expert body findings were that the continuation of pregnancy did not pose any grave risk to the physical or mental health of AB, and that there was no indication that the prospective child was likely to suffer from a congenital disorder. The judgment held that termination of pregnancy without consent would not be in AB’s ‘best interests’ and that the courts could not order a termination without consent when the MTP Act clearly respects the personal autonomy of mentally retarded persons who are above the age of majority. The court noted that the chairperson of the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities had submitted that the Trust was prepared to look after the best interests of AB, including assistance with childcare. Given concerns about AB’s ability to cope with the demands of carrying a child to full term, giving birth to the child, and childcare, the court directed that the best medical facilities be made available to her to ensure proper care and supervision during the pregnancy period as well as after.

Subsequent events have shown the wisdom of the apex court’s judgment in reversing the high court order of termination of pregnancy. AB was subjected to the trauma of sexual intercourse without her consent, that is, rape, while at the state-run home. Even with consent, abortion can be a traumatic invasion of the self and the body. Subjecting AB to an abortion against her consent would have resulted in further trauma to her, with deleterious effects on her mental health. Indeed, an invasive procedure such as medical termination of pregnancy without consent is violative of the integrity of the body, an integral facet of the right to life and liberty guaranteed under Article 21 of the Indian Constitution.

AB gave birth to a daughter on December 3, 2009. To quote Dr Raj Bahadur, director, Government Medical College and Hospital, Chandigarh, and the person in charge of Ashreya: “To be honest, even I am surprised at the tremendous maternal instincts she is showing. In fact, even her mental health has improved considerably after the child’s birth.”

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  Lab Update (Dr Arpan Gandhi and Dr Navin Dang)

Potassium

  • Hyperkalemia or increase in serum potassium is seen in states characterized by excess destruction of cells, with redistribution of K+ from the intra– to the extracellular compartment, as in massive hemolysis, crush injuries, hyperkinetic activity, and malignant hyperpyrexia. Decreased renal K+ excretion is seen in acute renal failure, some cases of chronic renal failure, Addison’s disease, and other sodium–depleted states. Hyperkalemia due to pure excess of K+ intake is usually iatrogenic.
  • Spurious hyperkalemia can be seen when a patient exercises his/her arm with the tourniquet in place prior to venipuncture. Hemolysis and marked thrombocytosis may cause false elevations of serum K+ as well. Failure to promptly separate serum from cells in a clot tube is a notorious source of falsely elevated potassium.
  • Hypokalemia or decrease in serum potassium is seen usually in states characterized by excess K+ loss, such as in vomiting, diarrhea, villous adenoma of the colorectum, certain renal tubular defects, hypercorticoidism, etc. Redistribution hypokalemia is seen in glucose/insulin therapy, alkalosis (where serum K+ is lost into cells and into urine), and familial periodic paralysis.
 
    Mind Teaser

Read this…………………

Which drug would be least effective in lowering a client's serum potassium level?

A. Glucose and insulin
B. Polystyrene sulfonate
C. Calcium glucomite
D. Aluminum hydroxide

Yesterday’s Mind Teaser: A nurse is directed to administer a hypotonic intravenous solution. Looking at the following labeled solutions, she should choose

A. 0.45% NaCl
B. 0.9% NaCl
C. D5W
D. D5NSS

Answer for Yesterday’s Mind Teaser: A. 0.45% NaCl

Correct answers received from: Dr A K Kela, Rajiv Kohli, Dr Ashutosh Aggarwal, Prabha Sanghi,
Dr Bina R Sawhney, Dr A K Jalewa, Dr PC Das, Dr BB Aggarwal, Dr (Maj. Gen.) Anil Bairaria, YJ Vasavada, Dr Kanta Jain, Dr K Raju, Dr Pankaj Agarwal, Dr Jainendra Upadhyay, Dr Avtar Krishan,
Dr Yogesh Kumar Swarnkar, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Parimalshah, Surindergrover, Dr Prabodh Kumar Gupta

Answer for 2nd September Mind Teaser: D. fluid and electrolyte monitoring
Correct answers received from: Dr Ajay Gandhi, Dr Mohit Sharma, Dr (Maj. Gen.) Anil Bairaria, Dr BB Aggarwal, Dr PC Das, Dr BK Agarwal.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

Jack's Last Will and Testament

Jack has died. His lawyer is standing before the family and reads out Jack's Last Will and Testament:

"To my dear wife Esther, I leave the house, 50 acres of land, and 1 million dollars…

"To my son Barry, I leave my Big Lexus and the Jaguar…

"To my daughter Suzy, I leave my yacht and $250,000…

"And to my brother-in-law Jeff, who always insisted that health is better than wealth, I leave my treadmill.

 
  Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What is panic disorder?

Panic disorder is a condition of vulnerability to stress with repeated sudden attack of panic with sustained anxiety and recurrence of panic.

  • This is a period of distress and apprehension, with somatic symptoms of feeling of choking, breathing trouble, trembling with a fearful feeling that he may go insane or may even die.
  • The attack may last for a few seconds to a few hours; the peak of distress is usually felt by about 10 minutes after starting.
  • Recurrence is also sudden, it can be said to be a part of anxiety, phobia and stress disorder syndrome
  • Treatment is Psychotherapy i.e. encouraging thoughts to be free from anxiety plus Benzodiazepines group of drugs.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Hooda: NGO’s should come forward for the welfare of the society

Mr. Bhupinder Singh Hooda, Chief Minister of Haryana in a message to Heart Care Foundation of India said that the Haryana Government has taken a number of initiatives to make modern health services easily accessible to the public, specially, to those belonging to the weaker sections of the society. He said that Haryana Government is providing medicines free of cost to the patients. With a view to provide cost-effective and hassle-free facilities for surgery to patients in government hospitals. A simple and comprehensive surgery package from time to time has also been implemented in the State.

In his message to the foundation for organizing Dil Ka Darbar on 23rd September, 2012 at Talkatora Stadium, he said that NGOs should continue to make the valuable contribution for the welfare of the society.

Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India said that free second opinion will be provided to the heart patients in the Darbar.

 
    Readers Response
  1. Dear Sir, You are rendering great help to our medical fraternity. Yours kindly Dr sanjay kohli.
 
    Forthcoming Events
Dr K K Aggarwal


Dr K K Aggarwal


Dr K K Aggarwal

Dil Ka Darbar

September 23, 2012 at 9:00 AM – 6:00 PM
Tal Katora Indoor Stadium, Connaught Place, New Delhi, 110001
A non stop question answer-session between all the top cardiologists of the NCR region and the public. Event will be promoted through hoardings, our publications and the press. Public health discussions
http://www.heartcarefoundation.org

TOGETHER WE CAN

RELAX *RECREATE* REJUVENATE

Weekend Retreat for Doctors on
Mind – Body – Medicine

8 (Sat) – 9 (Sun) September 2012 At Brahma Kumaris Om Shanti Retreat Centre NH–8, Bhorakalan, Pataudi Road, Bilaspur Chowk, Distt.-Gurgaon

There is NO REGISTRATION FEE but REGISTRATION is MUST
Visit us at: www.togetherwecan.in
Contact: BK Sister Sapna – M – 9650692204
E–mail: bksapna108@gmail.com

 
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